19 July 2010 - Isolated office hypertension (IOH), also known as "white-coat" hypertension, is associated with aortic stiffness and left ventricular hypertrophy (LVH) in patients being treated for hypertension and Type 2 diabetes (T2D), suggest study findings. 

"IOH has been associated with structural cardiac abnormalities; however, its relation to worse cardiovascular prognosis remains uncertain," write Gil Salles, MD (Federal University of Rio de Janeiro, Brazil) and colleagues in the journal Hypertension Research. They also say that little is known about the consequences of uncontrolled IOH in treated hypertensives, especially those with T2D. 

Salles and colleagues assessed whether IOH was independently linked to aortic stiffness, measured by carotid-femoral pulse wave velocity (PWV), and left ventricular mass index (LVMI), measured by echocardiography, in 523 pharmacologically-treated hypertensive patients with T2D. 

The researchers measured office blood pressure (BP) and 24-hour ambulatory BP for all the patients. Office systolic/diastolic BP of 140/90 mmHg or above and ambulatory BP below 130/80 mmHg were used to diagnose uncontrolled IOH, whereas controlled office-ambulatory hypertension was defined by office and 24-hour ambulatory BP below 140/90 mmHg and below 130/80 mmHg, respectively. Overall, 29.1% of patients had controlled office-ambulatory hypertension and 32.9% had uncontrolled IOH. 

Patients with IOH had significantly greater LVMI and PWV than those with controlled hypertension, at 62.0 versus 52.9 gm^-2.7 and 11.5 versus 10.2 m/s, respectively. This association persisted in significance following adjustment for various confounding factors such as age, gender, micro- or macrovascular diabetic complications, dyslipidemia. Uncontrolled IOH was found to increase the risk for aortic stiffness and LVH 2.7- and 2.1-fold, respectively, in T2D with treated hypertension. 

"These relationships may be a pathophysiological link to augmented cardiovascular risk independent of other established determinants of cardiovascular damage; and uncontrolled IOH shall not be considered a benign condition in Type 2 diabetic patients," conclude the researchers.